Risk factors for radiation pneumonitis after stereotactic radiation therapy for lung tumours: clinical usefulness of the planning target volume to total lung volume ratio

Ueyama, T.; Arimura, Takeshi; Takumi, Koji; Nakamura, Fumihiko; Higashi, Ryutaro; Ito, Shigeaki; Fukukura, Yoshihiko; Umanodan, Tomokazu; Nakajo, Masanori; Koriyama, Chihaya; Yamada, Takashi

doi:10.1259/bjr.20170453

Cited by 20 publications

(21 citation statements)

References 28 publications

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“…The risk factors for radiation pneumonitis have been reported to include the timing and schedule of RT sessions, the mean lung dose, the target volume and dose, pre-existing lung disease, and circulating cytokines. [22][23][24] The risk factors for immunotherapy-related pneumonitis have not been defined; however, suggestions have included active smoking, which we were unable to confirm in our study. 25 Little is known about which risk factors increase the likelihood of irAEs overall and pneumonitis in particular, and what effect irAEs might have on survival.…”

Section: Discussionmentioning

confidence: 67%

Incidence, Risk Factors, and Effect on Survival of Immune-related Adverse Events in Patients With Non–Small-cell Lung Cancer

Owen

Wei

Bertino

et al. 2018

Clinical Lung Cancer

112

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Section: Discussionmentioning

confidence: 67%

Incidence, Risk Factors, and Effect on Survival of Immune-related Adverse Events in Patients With Non–Small-cell Lung Cancer

Owen

Wei

Bertino

et al. 2018

Clinical Lung Cancer

112

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“…PTV/lung volume ratio has been shown a reliable factor for predicting lung dose [ 17 , 18 ]. In this study, as 6 out of 20 patients had neck lymph node metastasis, physical and EQD 2 total lung V 20 had poor linear correlations with volume ratio (LN to total lung) .…”

Section: Discussionmentioning

confidence: 99%

Regression models for predicting physical and EQD2 plan parameters of two methods of hybrid planning for stage III NSCLC

Wang

Zhou

Gan³

et al. 2021

Radiat Oncol

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Background/purpose To establish regression models of physical and equivalent dose in 2 Gy per fraction (EQD2) plan parameters of two kinds of hybrid planning for stage III NSCLC. Methods Two kinds of hybrid plans named conventional fraction radiotherapy & stereotactic body radiotherapy (C&S) and conventional fraction radiotherapy & simultaneous integrated boost (C&SIB) were retrospectively made for 20 patients with stage III NSCLC. Prescription dose of C&S plans was 2 Gy × 30f for planning target volume of lymph node (PTVLN) and 12.5 Gy × 4f for planning target volume of primary tumor (PTVPT), while prescription dose of C&SIB plans was 2 Gy × 26f for PTVLN and sequential 2 Gy × 4f for PTVLN combined with 12.5 Gy × 4f for PTVPT. Regression models of physical and EQD2 plan parameters were established based on anatomical geometry features for two kinds of hybrid plans. The features were mainly characterized by volume ratio, min distance and overlapping slices thickness of two structures. The possibilities of regression models of EQD2 plan parameters were verified by spearman’s correlation coefficients between physical and EQD2 plan parameters, and the influence on the consistence of fitting goodness between physical and EQD2 models was investigated by the correlations between physical and EQD2 plan parameters. Finally, physical and EQD2 models predictions were compared with plan parameters for two new patients. Results Physical and EQD2 plan parameters of PTVLN CI60Gy have shown strong positive correlations with PTVLN volume and min distance(PT to LN), and strong negative correlations with PTVPT volume for two kinds of hybrid plans. PTV(PT+LN) CI60Gy is not only correlated with above three geometry features, but also negatively correlated with overlapping slices thickness(PT and LN). When neck lymph node metastasis was excluded from PTVLN volume, physical and EQD2 total lung V20 showed a high linear correlation with corrected volume ratio(LN to total lung). Meanwhile, physical total lung mean dose (MLD) had a high linear correlation with corrected volume ratio(LN to total lung), while EQD2 total lung MLD was not only affected by corrected volume ratio(LN to total lung) but also volume ratio(PT to total lung). Heart D5, D30 and mean dose (MHD) would be more susceptible to overlapping structure(heart and LN). Min distance(PT to ESO) may be an important feature for predicting EQD2 esophageal max dose for hybrid plans. It’s feasible for regression models of EQD2 plan parameters, and the consistence of the fitting goodness of physical and EQD2 models had a positive correlation with spearman’s correlation coefficients between physical and EQD2 plan parameters. For total lung V20, ipsilateral lung V20, and ipsilateral lung MLD, the models could predict that C&SIB plans were higher than C&S plans for two new patients. Conclusion The regression models of physical and EQD2 plan parameters were established with at least moderate fitting goodness in this work, and the models have a potential to predict physical and EQD2 plan parameters for two kinds of hybrid planning.

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“…Numerous studies indicated that dosimetric parameters, such as mean lung dose (MLD), V 5 , V 10 , V 20 , V 30 , V 40 , V 50 , were associated with the occurrence of RP. [22][23][24][25] All metrics above were evaluated in our study. According to the study conducted by Sheng et al, 25 total lung V 5 , V 20 , V 30 and mean dose were all correlated with grade ≥2 RP, furthermore, lung V 30 was the independent risk factor.…”

Section: Discussionmentioning

confidence: 99%

<p>Sparing Organs at Risk with Simultaneous Integrated Boost Volumetric Modulated Arc Therapy for Locally Advanced Non-Small Cell Lung Cancer: An Automatic Treatment Planning Study</p>

Wang

Chen

Zhang

et al. 2020

CMAR

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Background: The technique of simultaneous integrated boost volumetric modulated arc therapy (SIB-VMAT) has been widely used in locally advanced non-small cell lung cancer; however, its dosimetric advantages are seldom reported. This study aimed to quantify dosimetric advantages of SIB-VMAT. Methods: Forty patients with stage III non-small cell lung cancer in our hospital were retrospectively included. SIB-VMAT and conventional VMAT (C-VMAT) plans were generated for every patient using the automatic treatment planning system. A reduced dose was delivered to PTV in SIB-VAMT plans compared to C-VMAT plans (50.4Gy vs 60Gy). The prescribed dose was 50.4 Gy in 28 fractions to PTV and 59.92 Gy in 28 fractions to PGTV in SIB-VMAT plans, while 60 Gy in 30 fractions to PTV in C-VMAT plans. Dose-volume metrics of PTV, total lung, heart, esophagus and spinal cord were recorded. The quality score was used to evaluate organs at risk (OAR) protection for two type prescription plans. Results: Conformal coverage of the targets (PGTV/PTV) by 95% of the prescription dose was well achieved in radiation plans. SIB-VMAT plans achieved significantly higher quality score than C-VMAT plans (Mean: 68.15±13.32 vs 49.15±13.35, P<0.001). More plans scored above sixty in SIB-VMAT group compared to C-VMAT group (72.5% vs 20%, P<0.001). Notable reductions in mean dose, V 30 , V 40 and V 50 of total lung were observed in SIB-VMAT plans compared to C-VMAT plans, with median decreased proportions of 6.5%, 8.7%, 19.6% and 32.1%, respectively. Statistically significant decrease in heart V 30 and V 40 was also achieved in SIB-VMAT plans, with median decreased proportions of 26.1% and 38.8%. SIB-VMAT plans achieved significant reductions in the maximum doses to both esophagus and spinal cord. Patients with CTV/(GTV+GTVnd) ≥8.6 showed more notable decrease in total lung V 50 (median, 33.6% vs 28.8%, P=0.001) in SIB-VMAT plans compared to those with the ratio being less than 8.6. Conclusion: SIB-VMAT technique could lead to a substantial sparing of normal organs, including lung, heart, esophagus and cord, mainly through reducing high and inter-median dose exposure. Patients with CTV/(GTV+GTVnd) ≥8.6 might benefit more from SIB-VMAT.

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Risk factors for radiation pneumonitis after stereotactic radiation therapy for lung tumours: clinical usefulness of the planning target volume to total lung volume ratio

Abstract: PTV/Lung is a good predictor of symptomatic RP after SRT. Advances in knowledge: The cases with high PTV/Lung should be carefully monitored with caution for the occurrence of RP after SRT.

Cited by 20 publications

References 28 publications

Incidence, Risk Factors, and Effect on Survival of Immune-related Adverse Events in Patients With Non–Small-cell Lung Cancer

Incidence, Risk Factors, and Effect on Survival of Immune-related Adverse Events in Patients With Non–Small-cell Lung Cancer

Regression models for predicting physical and EQD2 plan parameters of two methods of hybrid planning for stage III NSCLC

<p>Sparing Organs at Risk with Simultaneous Integrated Boost Volumetric Modulated Arc Therapy for Locally Advanced Non-Small Cell Lung Cancer: An Automatic Treatment Planning Study</p>

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